If you have an additional person you want to authorize to drop off or pick up your pet please list them below:

Authorized Person:

How did you hear about us?*:

Authorized Person Phone:

Your Dog's Information

Dog's Name*:

Dog's DOB*:

Gender*:

Male
Female

Weight*:

Color*:

Breed (If mix, best guess)*:

Is your dog fixed*:

Yes

No

Does your dog have an ID tag?*:

Yes

No

Is your dog allowed on furniture?*:

Yes

No

Is your dog housebroken?*:

Yes

No

Is your dog a jumper?*:

Yes

No

Does your dog cough, wheeze, or exhibit any asthmatic symptoms?*:

If yes please explain*:

Yes

No

Has your dog ever been boarded or attended doggie daycare?*:

Yes

No

Dogs Behavior with people?

Fearful*:

Yes

No

Aggressive*:

Yes

No

Dominant*:

Yes

No

Submissive*:

Yes

No

Other:

Has your dog ever bitten another dog or human?*:

Yes

No

If yes please explain*:

Dogs Behavior with other Dogs?

Fearful*:

Yes

No

Aggressive*:

Yes

No

Dominant*:

Yes

No

Submissive*:

Yes

No

Other:

Has your dog ever bitten or snapped at another dog regardless of reason?*:

Yes

No

If yes please explain*:

Veterinarian Information

Name of Vet’s Office*:

Doctor’s Name:

Vet’s Telephone*:

Vet’s Fax:

Vet’s Address, City, and State*:

Flea Control*:

Yes

No

Heartworm Prevention*:

Yes

No

Heartworm Test*:

Yes

No

Vaccination Expiration Dates

Rabies*:

Bordetella (Kennel Cough)*:

DHLPP*:

Parvo Virus*:

Describe any health problems:

24 Hour Care (Boarding Dogs Only)

We ask that you supply us with your own dog food in order to maintain your dog’s normal diet. If you chose not to, we will serve your dog our “house food”. Cost $5.00 in addition you are encouraged to bring anything that will help your dog feels more at home.(toys, bedding etc.)

Feeding Instructions

Breakfast*:

Yes

No

Lunch*:

Yes

No

Dinner*:

Yes

No

Treats Instructions

Breakfast*:

Yes

No

Lunch*:

Yes

No

Dinner*:

Yes

No

Medication

Medication*:

Yes

No

What medication is your dog on?*:

Time your dog need the medication?*:

Credit Card Information

Your credit card number is necessary in order to enroll your dog in daycare, boarding grooming, training or any other service we may do on your behalf. Your credit card will be used to guarantee payment of any services required for your pet.

Name on Card*:

Credit Card Type*:

Card Number*:

Exp Date*:

CVV Number*:

Billing Address*:

City*:

State*:

Zip*:

*I understand that my charge card is guaranteeing my reservation and any cost associated with my pet's stay. Also, if I fail to cancel my reservation before 72 hours of expected drop off time, I will be charged $45.00 per pet for failure to adhere to the cancellation policy.